Riddiough Georgina E, Hornby Steve T, Asadi Khashayar, Aly Ahmed
Austin Health, Department of Upper GI Surgery, 145 Studley Road, Heidelberg 3084, Australia.
Austin Health, Department of Upper GI Surgery, 145 Studley Road, Heidelberg 3084, Australia.
Int J Surg Case Rep. 2017;30:205-214. doi: 10.1016/j.ijscr.2016.11.014. Epub 2016 Dec 1.
Ectopic gastric mucosa (EGM) otherwise termed gastric heterotopia or gastric inlet patch occurs in approximately 2.5% of the population. Adenocarcinoma uncommonly involves the upper oesophagus, rarely arising from gastric heterotopia or submucosal glands. Currently, there are 58 cases in the literature of oesophageal adenocarcinoma arising within areas of EGM. To date no paper has differentiated between gastric or intestinal type adenocarcinoma. This case, which describes adenocarcinoma arising within EGM, exhibited a different immunophenotype reminiscent of gastric type glands, in the absence of intestinal metaplasia. This case should be regarded as a different type of carcinoma, consistent with a non-Barrett's oesophagus-associated adenocarcinoma.
A 63year old female presented with a three month history of progressive cervical dysphagia with no associated weight loss or general malaise. Gastroscopy revealed a suspicious lesion at the cricopharyngeus. Positron emission tomography demonstrated a metabolically active primary lesion without evidence of distant disease. The patient received neo-adjuvant chemotherapy followed by a three stage total oesophagectomy. Histology demonstrated a moderately differentiated adenocarcinoma with gastric immunophenotype and background changes of gastric heterotopia.
EGM is common but scarcely biopsied for evidence of dysplasia or adenocarcinoma. Whilst malignant progression is rare it is important that endoscopists are aware of the potential. Determining the exact type of adenocarcinoma may have implications for therapeutic approaches. Recognition of EGM at endoscopy may identify patients at greater risk of developing adenocarcinomas of the proximal oesophagus, however, this relationship and the necessity for screening requires more study.
异位胃黏膜（EGM），又称胃异位或胃入口黏膜斑，约见于2.5%的人群。腺癌很少累及食管上段，极少起源于胃异位或黏膜下腺体。目前文献中有58例食管腺癌发生于EGM区域。迄今为止，尚无论文区分胃型或肠型腺癌。本病例描述了发生于EGM内的腺癌，在无肠化生的情况下，表现出一种不同的免疫表型，类似于胃型腺体。该病例应被视为一种不同类型的癌，与非巴雷特食管相关腺癌一致。
一名63岁女性，有3个月进行性颈段吞咽困难病史，无体重减轻或全身不适。胃镜检查发现环状咽肌处有可疑病变。正电子发射断层扫描显示有一个代谢活跃的原发病变，无远处疾病证据。患者接受了新辅助化疗，随后进行了三阶段全食管切除术。组织学检查显示为中度分化腺癌，具有胃免疫表型及胃异位的背景改变。
EGM很常见，但很少进行活检以寻找发育异常或腺癌的证据。虽然恶性进展很少见，但内镜医师意识到这种可能性很重要。确定腺癌的确切类型可能对治疗方法有影响。在内镜检查中识别EGM可能会发现近端食管发生腺癌风险更高的患者，然而，这种关系以及筛查的必要性需要更多研究。
